Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME119374 | FL |
NPI | 1003198144 |
---|---|
Provider Name | Yissel Jorge Puig |
First Address | Hialeah, FL 33013-3810 |
Second Address | Hialeah, FL 33013-3810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2011 |
Last Update Date | 13/09/2021 |